Mr. Stephen Mulvany:

The largest income source we have for acute hospitals is the private maintenance charge, namely the charge which is levied on patients and paid by their private insurers, the four large companies which the Deputy will be aware of. There are two issues. First, the insurers have taken a stance in the last two years around the timing of when we are entitled to charge in their view. Our understanding of the legislation is very clear in that once the individual elects to be treated privately it is from the date of admission and the insurers are pursuing a line which says they will only pay from the date of a particular form being signed. We have an entirely different view from that. There is also what we would refer to as a campaign that the insurers are running, encouraging members not to use their insurance when admitted through the unscheduled care route into hospitals. Those two issues are matters which we are considering our options on and we are engaging with our colleagues in the Department. The reality is that it is having a financial impact and it had a significant financial impact in 2017. That is the €73 million.